011315 cirrhosis

Question 1

cirrhosis etiologies

Answer 1

hep B (D), hep C, alcohol, hemochromatosis, Wilson’s disease, non-alcholic steatohepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune hepatitis, alph-1 antitrypsin deficiency, Budd chiari syndrome

Question 2

cirrhosis–examination findings

Answer 2

cachexia (muscle loss), jaundice, ascites, spider angioma, Dupuytren’s contractures, pitting edema, breast development, testicular atrophy, palmar erythema, hair loss, encephalopathy

Question 3

lab findings for cirrhosis

Answer 3

elevated bilirubin
elevated transaminases
elevated alkaline phosphatase
decreased albumin
elevated PT/INR
thrombocytopenia
leukopenia
renal insufficiency
hyponatremia

Question 4

spider angioma differential

Answer 4

advanced liver disease or pregnancy

due to estrogen levels

Question 5

chronic cirrhosis-CT?

Answer 5

liver shrunken

spleen enlarged

Question 6

Child Pugh scoring criteria

Answer 6

assess degree of cirrhosis with subjective and objective factors

to assess to see if needs liver transplant

Question 7

what is used instead of Child Pugh now

Answer 7

model for end stage liver disease (MELD)–used b/c Child Pugh has subjective factors

Question 8

Budd Chiari

Answer 8

hepatic vein thrombosis

leads to portal HTN

Question 9

complications of cirrhosis

Answer 9

variceal bleed
ascites
spontaneous bacterial peritonitis (ascites becomes infected)
hepatorenal syndrome
hepatopulm syndrome
hepatic encephalopathy

Question 10

when spleen enlarges, what happens?

Answer 10

sequesters platelets and WBCs

thrombocytopenia, leukopenia

Question 11

to prevent variceal bleeds (for pt with varices that haven’t bled yet), what tx do you give

Answer 11

beta adrenergic blockers (non-selective beta blockers):
propranolol
nadolol

Question 12

bleeding esophageal varices show what symptoms

Answer 12

vomiting black blood

melena

Question 13

tx for active variceal hemorrhage

Answer 13

octreotide (decreases amt of blood coming into the portal vein)

band ligation

Question 14

how does hyponatremia result from cirrhosis?

Answer 14

cirrhosis causes portal HTN, splachnic arterial vasodilatation, decreased effective circulating volume, activation of vasoconstrictor and antinatriuretic factors, more water retention than sodium retention

Question 15

tx of ascites

Answer 15

2000 mg sodium restricted diet

diuretics (spironolactone to inhibit aldosterone, furosemide)

Question 16

signs and symptoms in pts with spontaneous bacterial peritonitis

Answer 16

abdominal pain
fever
encephalopathy

Question 17

pathogenesis in spontaneous bacterial peritonitis

Answer 17

E coli
Strep

mostly gram negative

Question 18

in hepatorenal syndrome, what happens to kidney?

Answer 18

vasoconstriction

Question 19

in hepatorenal syndrome, what happens to urine sodium? urine micro? central venous pressure?

Answer 19

urine sodium is under 10 mEq/L
urine micro is normal
central venous pressure is low

Question 20

does hydration tx hepatorenal syndrome?

Answer 20

no

Question 21

tx for hepatopulm syndrome?

Answer 21

only tx is to relieve vasodilated state, meaning:

only way would be to get new liver

Question 22

pathophysiology of hepatic encephalopathy

Answer 22

gut derived neurotoxins can no longer be processed by liver due to hepatic insufficiency or hepatic bypass in portal HTN, so they cross the BBB

Question 23

what symptoms can you see with encephalopathy

Answer 23

asterixis

squeeze finger test-cannot maintain tone

Question 24

tx for enchalopathy

Answer 24

lactulose (decreases pH and converts NH3 to NH4)

rifaximin (antibiotic)

Question 25

causes of ACUTE liver failure in the US

Answer 25

acetaminophen toxicity
drugs
hep B
pregnancy
etc

Question 26

fulminant liver failure

Answer 26

acute liver failure with hepatocyte necrosis (causing coagulopathy, encephalopathy)

cerebral edema (inability of liver to metabolize ammonia. ammonia converted into glutamine by brain astrocytes, leading to astrocyte swelling). LEADING CAUSE OF DEATH

Question 27

hepatorenal syndrome is compliciation of

Answer 27

ascites

Question 28

the three complications of ascites

Answer 28

SBP
hepatorenal syndrome
hyponatremia